This Spring, MassHealth is hosting several One Care outreach events to let individuals who may be eligible for One Care know about the benefits of the program.

One Care Presentations as well as Drop-In Events will be held throughout Suffolk and Worcester County between the dates of March 25th and April 13th. This is a great opportunity to learn more about One Care, particularly for clients who may have received notices indicating that they are being automatically assigned to a One Care plan. More information about One Care can also be found at: www.mass.gov/masshealth/onecare.

The state’s Executive Office of Health and Human Services (EOHHS) announced that one of the three health plans managing health care for dually eligible ages 21 to 64 through the One Care Demonstration Program will be dropping out.

As of September 30, 2015, Fallon Total Care will be parting ways with the capitated financial alignment program, which will leave Commonwealth Care Alliance and Network Health as the remaining plans. Fallon Total Care provides One Care coverage in Hampden, Hampshire, and Worcester counties to approximately 5,475 individuals and represented the second largest enrollment of the three plans. Commonwealth Care Alliance, as of the May 2015 enrollment report, was handling 10,305 dually eligible individuals.

“MassHealth assures members who are currently enrolled with Fallon Total Care (FTC) that we will work hard to ensure as smooth a transition as possible, working with current members, FTC, the other One Care plans, our partners at CMS, advocates, and the One Care Implementation Council,” stated MassHealth in a brief statement. “One Care members will not lose their MassHealth or Medicare, and all members will have continuous access to health care services, supportive services, and medications.”

MassHealth also promised further updates on the transition and did not share any reasoning for Fallon Total Care departing the One Care Program.

The One Care initiative provided stakeholders with an update on enrollment population as well as the financial methodology governing the program and survey results illustrating enrollee opinions and satisfaction with services and the care team.

One Care, which coordinates Medicare and MassHealth services for dually eligible individuals between 21 and 64 years old, reported that the program has spent 14 percent – or $19.4million – on home and community-based services, including home health. This number reflects the life of the program thus far since it launched in October 2013. Pharmacy services represents the largest piece of the spending pie at 25 percent ($34.36 million).

The program has also conducted a round of enrollee surveys that found the following:

Over 80% of enrollees had met with their PCP; most are satisfied with the PCP

Over 70% had met with their Care Coordinator; 90% are satisfied

There was confusion about the role of the LTS Coordinator

When asked if they needed/wanted LTS Coordinator, many said no, or not sure;

Only 39% said they needed/wanted an LTS Coordinator;

Less than 45% had met with an LTS Coordinator

One Care administrators worked with CMS to update the financial methodology that was intended to protect the three plans (Commonwealth Care Alliance, Fallon Total Care, Network Health) and that info, along with the broader report to stakeholders, is available in a PowerPoint presentation.

The One Care demonstration project that coordinates and combines services for dually eligible individuals in Massachusetts hosts periodic webinars to educate the One Care Plans as well as service providers to help the program be successful.

The latest in that series is a free webinar on the role of the Long Term Services and Supports Coordinator, which will take place on Thursday, September 18th from noon to 1:00pm. During this webinar, the One Care Learning Team will discuss making referrals to Independent Living and Long-Term Services (LTS) and Supports Coordinators, ways to explain this role to One Care enrollees, and the benefits of engaging LTS Coordinators on Interdisciplinary Care Teams. An overview of the vision of MassHealth for the role of LTS Coordinator will be outlined and highlighted with examples of how LTS Coordinators are working with enrollees and interdisciplinary care teams.

Check out this video for an overview of the Independent Living LTSS Coordinator role and meet two of the webinar presenters.

The Massachusetts One Care Initiative, which aims to better coordinate care and services for dually eligible individuals ages 21-64, officially launched the One Care Ombudsman program (OCO). Home health agencies involved in One Care should be aware of this new resource.

According to a notice sent by the state, the OCO:

Is an independent program operated by the Disability Policy Consortium (contracted by EOHHS) and its partners, Health Care For All (HCFA) and Consumer Quality Initiatives (CQI);

Addresses concerns and helps resolve conflicts regarding members’ enrollment in One Care or access to covered benefits and services so they can receive the benefits and exercise the rights they are entitled to in One Care; and

Works with members and their representatives, as well as MassHealth and the three One Care plans, to find resolutions to members’ concerns or complaints.

The OCO does not duplicate or replace other resources that are already available to help people with One Care (such as the SHINE program, the One Care plans’ member services, and MassHealth Customer Service). The OCO is an additional resource to support members who need or request independent problem-resolution assistance beyond what is available now. The OCO provides three main types of services: Read the rest of this entry »